• Luregn J Schlapbach, Maya C Andre, Serge Grazioli, Nina Schöbi, Nicole Ritz, Christoph Aebi, Philipp Agyeman, Manuela Albisetti, Douggl G N Bailey, Christoph Berger, Géraldine Blanchard-Rohner, Sabrina Bressieux-Degueldre, Michael Hofer, Arnaud G L'Huillier, Mark Marston, Patrick M Meyer Sauteur, Jana Pachlopnik Schmid, Marie-Helene Perez, Bjarte Rogdo, Johannes Trück, Andreas Woerner, Daniela Wütz, Petra Zimmermann, Michael Levin, Elizabeth Whittaker, Peter C Rimensberger, and PIMS-TS working group of the Interest Group for Pediatric Neonatal Intensive Care (IGPNI) of the Swiss Society of Intensive Care and the Pediatric Infectious Diseases Group Switzerland (PIGS).
• Pediatric and Neonatal Intensive Care Unit, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
• Front Pediatr. 2021 Jan 1; 9: 667507.

AbstractBackground: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce. Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing. Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach >80% agreement for acceptance. Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation. Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged.Copyright © 2021 Schlapbach, Andre, Grazioli, Schöbi, Ritz, Aebi, Agyeman, Albisetti, Bailey, Berger, Blanchard-Rohner, Bressieux-Degueldre, Hofer, L'Huillier, Marston, Meyer Sauteur, Pachlopnik Schmid, Perez, Rogdo, Trück, Woerner, Wütz, Zimmermann, Levin, Whittaker, Rimensberger and the PIMS-TS working group of the Interest Group for Pediatric Neonatal Intensive Care (IGPNI) of the Swiss Society of Intensive Care and the Pediatric Infectious Diseases Group Switzerland (PIGS).

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